[Atropine poisoning by Mandragora autumnalis. A report of 15 cases]. / Intoxicación atropínica por Mandragora autumnalis. Descripción de quince casos.

Anticholinergic syndrome (AS) due to accidental poisoning is exceptional. Mandragora contains a high concentration of atropine, hiosciamine and scopolamine. We have evaluated 15 patients with AS due to poisoning by Mandragora autumnalis, distributed in two family groups. The latency period since the ingestion was 1-4 hours (Means = 2.7 +/- 0.9). The clinical features corresponded to an AS of variable severity. All patients had blurred vision and dryness of mouth, nine (60%) had difficult micturition, nine dizziness, nine headache, eight (53%) vomit, two difficult swallowing and two abdominal pain. There was no correlation between the latency period and the clinical severity. Blushing, areactive mydriasis and tachycardia were found in all, dry skin and mucosae in 14 (93%), hyperactivity/hallucination in 14 and agitation/delirium in nine (60%). One patient developed a florid psychotic episode. Prostigmine (2-6 mg) was administered to 11 patients and physostigmine (0.5-2 mg) to six. The time until a definite response was observed was variable (3-36 hours). The patients treated with physostigmine had a better reversal of the psychoneurological symptoms. Mandragora was identified intermingled with chard [correction of stalwort] (Beta vulgaris) and spinach (Spinacia oleracea) leaves, and atropine and hiosciamine were identified.

[Classical heatstroke in Spain. Analysis of a series 78 cases]. / Golpe de calor clásico en España. Análisis de una serie de 78 casos.

Seventy-eight cases of classical heat stroke (HS) seen during the summer of 1988 and 1989 have been evaluated. The diagnosis was established on the basis of classically accepted criteria (severe hyperthermia, impairment of the level of consciousness, anhydrosis, exposure to high environmental temperature). 62.8% of patients were females, with a mean age of 75 +/- 12.3 years. All patients had predisposing factors and 57.7% was taking facilitating drugs. 86% of the patients had 2 or more predisposing or facilitating factors. In 45 cases there were prodromic features. The suspicion of HS was not raised in any of the referring services. Hyperglycemia was present in 89.7% of cases, increased blood urea in 85.9%, high creatine kinase in 74.3%, abnormal coagulation in 52.9%, hypernatremia in 46.2%, hyponatremia in 37.2%, hypokalemia in 35.9%, hyperkalemia in 23.1%, metabolic acidosis in 41.1% and respiratory alkalosis in 36.9%. Electrocardiogram was abnormal in 95.4%. 31 patients (39.7%) died. Death was more common in patients with deep coma, shock, and higher blood urea levels. The present study demonstrates the occurrence of this condition in our area.